Sleep difficulties during menopause and perimenopause
We work with women who are experiencing sleep difficulties during menopause or perimenopause. Our aim is to understand all of the symptoms you are experiencing and design a management plan that will enable you to achieve good sleep once again. We'll talk you through the options available to you, which may include lifestyle adjustments, hormonal treatment or psychological therapies such as CBT for hot flushes and night sweats, and design a management plan to help you achieve better sleep.
Insomnia Associated with the Menopausal Transition
Sleep disturbances are one of the most common symptoms of the menopausal transition and can have a very negative impact on a woman's quality of life.
What is the menopause?
The term menopause is defined as the time 12 months after a woman’s final menstrual period. The perimenopause or ‘menopausal transition’ begins with the first menopausal symptoms and ends 12 months after the last menstrual period.
What are menopausal symptoms?
The perimenopause is associated with many hormonal changes including reduced production of oestrogen, progesterone and testosterone. These hormonal changes lead to a wide variety of symptoms including temperature changes (hot flushes and night sweats), mood changes, vaginal symptoms of dryness and irritation and sleep disturbances.
There are many other symptoms of the menopause, and we often use a menopause symptom questionnaire to ask women about their wider experience.
How is sleep affected in the menopausal transition?
Sleep disturbances are one the most common symptoms of the perimenopause and 40-60% of women report difficulties staying asleep, and waking more during the night (“sleep maintenance insomnia”). Often this leads to very reduced sleep and for many women this means less than 6 hours of sleep per night.
Why is sleep disturbed during the menopausal transition?
There are a number of possible reasons for the increase in sleep problems at this time. Hormonal changes are likely to play a big part in this, with women experiencing deficiency of oestrogen as they move through the menopausal transition. It is also likely to be related to temperature changes which are often worse and more troublesome during the night.
Hot flushes or sweats at night time frequently trigger awakening during the night, and often women will struggle to return to sleep. The perimenopause is also associated with increased mood symptoms, women commonly experience heightened anxiety and low mood.
These symptoms in themselves can impact on sleep, and a combination of mood symptoms and temperature symptoms can make sleep extremely challenging during this time of life. We also see an increased rate of sleep apnoea (a disorder of breathing during sleep) during the menopausal transition and we always ask our clients about symptoms of snoring and breathing difficulties at night.
How we treat sleep problems associated with the perimenopause.
At The Good Sleep Clinic we believe it is important to treat sleep problems as early as possible during the perimenopause to restore good sleep. If left untreated, sleep disturbances can become prolonged and more difficult to treat many years later. We often see clients who have had insomnia for many years, and when looking back we find that the problems began during the perimenopausal years and were not treated at the time, developing into long-term, established insomnia.
There are many options that can improve sleep during the perimenopause. Hormone replacement therapy can be extremely effective and safe, and if taken close to the time of the menopause it can bring a range of other health benefits.
This usually involves taking an oestrogen treatment to address the deficiency that arises during the perimenopause, which is very effective at resolving temperature changes (flushes and sweats) and other menopausal symptoms. The oestrogen is often combined with a progesterone treatment which can have a calming effect and when taken at night can help to improve sleep.
For women who are unable to, or do not wish to use hormonal methods there are other options available including Cognitive Behavioural Therapy for Insomnia - we offer CBT that is tailored towards menopausal symptoms. This can help to improve sleep and helps to develop coping skills and useful strategies to manage other menopausal symptoms.
There are other medication options that can be effective for sleep and menopausal symptoms and we will discuss these with you following an individual assessment to understand your medical history as well as your symptoms and priorities for treatment.